The effect of uncemented acetabular liner geometry and lip size on the risk of revision for instability or loosening

2021 ◽  
Vol 103-B (12) ◽  
pp. 1774-1782
Author(s):  
Hiren M. Divecha ◽  
Terence W. O'Neill ◽  
Mark Lunt ◽  
Tim N. Board
Keyword(s):  
Surgical Approach ◽  
Lower Risk ◽  
National Joint Registry ◽  
Institution Type ◽  
Joint Registry ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Hip Arthroplasties ◽  
Acetabular Components

Aims The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the National Joint Registry (NJR) dataset between 2003 and 2017. The effect of liner geometry on the risk of revision for instability or loosening was investigated using competing risk regression analyses adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, surgeon grade, surgical approach, head size, and polyethylene crosslinking. Stratified analyses by surgical approach were performed, including pairwise comparisons of liner geometries. Results The distribution of liner geometries were neutral (39.4%; 79,822), 10° (34.5%; 69,894), 15° (21.6%; 43,722), offset reorientating (2.8%; 5705), offset neutral (0.9%; 1,767), and 20° (0.8%; 1,601). There were 690 (0.34%) revisions for instability. Compared to neutral liners, the adjusted subhazard ratios of revision for instability were: 10°, 0.64 (p < 0.001); 15°, 0.48 (p < 0.001); and offset reorientating, 1.6 (p = 0.010). No association was found with other geometries. 10° and 15° liners had a time-dependent lower risk of revision for instability within the first 1.2 years. In posterior approaches, 10° and 15° liners had a lower risk of revision for instability, with no significant difference between them. The protective effect of lipped over neutral liners was not observed in laterally approached THAs. There were 604 (0.3%) revisions for loosening, but no association between liner geometry and revision for loosening was found. Conclusion This registry-based study confirms a lower risk of revision for instability in posterior approach THAs with 10° or 15° lipped liners compared to neutral liners, but no significant difference between these lip sizes. A higher revision risk is seen with offset reorientating liners. The benefit of lipped geometries against revision for instability was not seen in laterally approached THAs. Liner geometry does not seem to influence the risk of revision for loosening. Cite this article: Bone Joint J 2021;103-B(12):1774–1782.

The effect of cemented acetabular component geometry on the risk of revision for instability or loosening

2021 ◽  
Vol 103-B (11) ◽  
pp. 1669-1677
Author(s):  
Hiren M. Divecha ◽  
Terence W. O'Neill ◽  
Mark Lunt ◽  
Tim N. Board
Keyword(s):  
Acetabular Component ◽  
Posterior Wall ◽  
Revision Thas ◽  
Joint Registry ◽  
Binomial Regression ◽  
Prosthetic Head ◽  
Group A ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Acetabular Components

Aims To determine if primary cemented acetabular component geometry (long posterior wall (LPW), hooded, or offset reorientating) influences the risk of revision total hip arthroplasty (THA) for instability or loosening. Methods The National Joint Registry (NJR) dataset was analyzed for primary THAs performed between 2003 and 2017. A cohort of 224,874 cemented acetabular components were included. The effect of acetabular component geometry on the risk of revision for instability or for loosening was investigated using log-binomial regression adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, operating surgeon grade, surgical approach, polyethylene crosslinking, and prosthetic head size. A competing risk survival analysis was performed with the competing risks being revision for other indications or death. Results The distribution of acetabular component geometries was: LPW 81.2%; hooded 18.7%; and offset reorientating 0.1%. There were 3,313 (1.5%) revision THAs performed, of which 815 (0.4%) were for instability and 838 (0.4%) were for loosening. Compared to the LPW group, the adjusted subhazard ratio of revision for instability in the hooded group was 2.31 (p < 0.001) and 4.12 (p = 0.047) in the offset reorientating group. Likewise, the subhazard ratio of revision for loosening was 2.65 (p < 0.001) in the hooded group and 13.61 (p < 0.001) in the offset reorientating group. A time-varying subhazard ratio of revision for instability (hooded vs LPW) was found, being greatest within the first three months. Conclusion This registry-based study confirms a significantly higher risk of revision after cemented THA for instability and for loosening when a hooded or offset reorientating acetabular component is used, compared to a LPW component. Further research is required to clarify if certain patients benefit from the use of hooded or offset reorientating components, but we recommend caution when using such components in routine clinical practice. Cite this article: Bone Joint J 2021;103-B(11):1669–1677.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

Electroacupuncture at St36 Accelerates the Recovery of Gastrointestinal Motility after Colorectal Surgery: A Randomised Controlled Trial

2014 ◽  
Vol 32 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Zhaodi Zhang ◽  
Changsong Wang ◽  
Quanyi Li ◽  
Mingyue Zhang ◽  
Haifang Zhao ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Gastrointestinal Motility ◽  
Controlled Trial ◽  
Bowel Function ◽  
Group 13 ◽  
Group Data ◽  
Significant Difference ◽  
American Society ◽  
Randomised Controlled ◽  
American Society Of Anesthesiologists

Objectives To evaluate whether electroacupuncture (EA) at ST36 can accelerate the recovery of gastrointestinal motility after colorectal surgery. Methods Forty patients of American Society of Anesthesiologists physical status II and III undergoing elective open resection of malignant colorectal tumours were included in this study. Using a sealed envelope method, the patients were randomly divided into two groups either receiving EA (EA group) or sham EA (SEA group). Data regarding the recovery of bowel function (times to the first bowel sounds, passage of flatus and defaecation) were collected and analysed. Results In the EA group, the time intervals from surgery to the first bowel movement and passage of flatus were shorter than in the SEA group (13±10 h vs 19±13 h, p<0.05 and 23±14 h vs 32±18 h, p<0.05, respectively). There was no significant difference between the groups regarding the time to first defaecation (68±45 h vs 72±53 h, p>0.05). Conclusions EA at ST36 accelerates the recovery of gastrointestinal motility after colorectal surgery. Trial Registration JJ22011-15.

scholarly journals A comparative evaluation of efficacy of epidural dexmedetomidine and fentanyl as adjunct to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries

2020 ◽  
Author(s):  
Pushpal Gandhi ◽  
Mahendra Agrawal ◽  
Bhavika Agrawal ◽  
Simarn Behl
Keyword(s):  
Epidural Analgesia ◽  
Comparative Evaluation ◽  
Hemodynamic Parameters ◽  
Regional Technique ◽  
Significant Difference ◽  
Group 2 ◽  
Reversible Loss ◽  
American Society ◽  
The One ◽  
American Society Of Anesthesiologists

<p class="abstract"><strong>Background:</strong> Epidural analgesia as a central nuraxial technique which involves use of local anesthetics injected into the epidural space to produce a reversible loss of sensation and is the one of the most common regional technique used for lover abdominal and lover limb surgeries epidural analgesia provides excellent pain relief for surgical procedures below the umbilicus. This study compared the efficacy of epidural dexmedetomidine and fentanyl in addition to 0.2% ropivacaine for post-operative analgesia in elective abdominal surgeries.</p><p class="abstract"><strong>Methods:</strong> Total of 150 patients American Society of Anesthesiologists (ASA) I and II between 20-60 years, undergoing major abdominal surgery were included in this study. The patients divided in three groups of 50 patients each. First group R (ropivaciain 0.2% 9 ml with 1ml normal saline) second group RF (ropivacain 0.2% 9 ml with fentanyl 1 ml) and third group RD (ropivaciain 0.2% 9 ml with dexmedetomidine 1 μ/kg).</p><p class="abstract"><strong>Results:</strong> There is no significant difference in age, weight, sex, and ASA grade in all three groups.</p><p class="abstract">Hypotension was observed in 4 (8%) patients of R group, 2 (4%) in RD group and 4 (8%) in RF group. The shivering was present in 2 (4%) R group and 2 (4%) in RD group.  Nausea, vomiting was present in R group 2 (4%) and 2 (4%) in RF group. There was no significant difference between the three groups with respect to hemodynamic parameters like heart rate, systolic and diastolic blood pressure and respiratory rate.</p><p class="abstract"><strong>Conclusions: </strong>Dexmedetomidine is a better adjuvant to ropivacaine through epidural route when compared to fentanyl for providing early onset prolonged post-operative analgesia, sedation and stable hemodynamic parameters in intra-abdominal surgeries.</p>

Complicated Appendicitis–Is the Laparoscopic Approach Appropriate? A Comparative Study with the Open Approach: Outcome in a Community Hospital Setting

2007 ◽  
Vol 73 (8) ◽  
pp. 737-742 ◽  
Author(s):  
Naveen Pokala ◽  
S. Sadhasivam ◽  
R.P. Kiran ◽  
V. Parithivel
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Complicated Appendicitis ◽  
Complication Rates ◽  
Intraabdominal Abscess ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Good outcome has been reported with the laparoscopic approach in uncomplicated appendicitis, but a higher incidence of postoperative intraabdominal abscesses has been reported after laparoscopic appendectomy in complicated appendicitis. This retrospective comparative study compares outcome after laparoscopic (LA) and open appendectomy (OA) in complicated appendicitis. All patients who had LA or OA for complicated appendicitis between January 2003 and February 2006 were included in the study. Data collection included demographics, operative time, estimated blood loss, length of stay (LOS), complications, readmission, and reoperative rates. The primary end points for analysis were postoperative intraabdominal abscess and complication rates and secondary end points were LOS and operative time. All data were analyzed on an intent-to-treat basis. Of 104 patients, 43 patients underwent LA and 61 had OA. The mean age (24.8 ± 16.5 versus 31.3 ± 18.9, P = 0.08) in the LA group was lower than the OA group because there was a significantly higher proportion of pediatric patients (34.8% versus 14.8%, P = 0.02) who had LA. There was no significant difference in gender (female/male, 14/29 versus 27/34, P = 0.3) or American Society of Anesthesiologists class distribution (American Society of Anesthesiologists 1/2/3/4/, 35/7/1/0 versus 45/12/3/1, P = 0.68) between the two groups. The operative time (100.5 ± 36.2 versus 81.5 ± 29.5 minutes, P = 0.03) was significantly longer and the estimated blood loss (21 mL versus 33 mL, P = 0.01) was lower in LA when compared with OA, but there was no significant difference in the number of patients with preoperative peritonitis versus abscesses (7/36 versus 13/48, P = 0.6) in both groups. There was no difference in the median LOS (6 [interquartile range 5–9] versus 6 [interquartile range 4–8], P = 0.7) in the two groups. The conversion rate in LA was 18.6% (n = 8). There was also no significant difference in the complication (17/43 [39.5%] versus 21/61 [34.4%], P = 0.54), reoperative (3/43 [7%] versus 0/61 [0%], P = 0.07), and 30-day readmission (5/41 [11.6%] versus 3/61 [4.9%], P = 0.23) rates between the two groups. The rate of postoperative intraabdominal abscesses was significantly higher in the LA group when compared with the OA group (6/43 [14%] versus 0/61 [0%], P = 0.04) and the wound infection (1/43 [2.3%] versus 5/61 [8.2%], P = 0.4) and pulmonary complication (0/43 [0%] versus 3/61 [4.9%], P = 0.26) rate was higher in the OA group. There was no mortality in the LA group, but there was one mortality in the OA group resulting from postoperative myocardial infarction. Laparoscopic appendectomy can be performed in patients with complicated appendicitis with a comparative operative time, LOS, and complication rates but results in a significantly higher intraabdominal abscess rate and lower wound infection rate when compared with OA.

scholarly journals Intraoperative Tranexamic Acid Reduces Blood Transfusion in Children Undergoing Craniosynostosis Surgery

2011 ◽  
Vol 114 (4) ◽  
pp. 856-861 ◽  
Author(s):  
Christophe Dadure ◽  
Magali Sauter ◽  
Sophie Bringuier ◽  
Michelle Bigorre ◽  
Olivier Raux ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Surgical Correction ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Surgical Data ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background Surgical correction of craniosynostosis in children is associated with substantial intraoperative bleeding. Tranexamic acid (TXA) decreases intraoperative blood loss during cardiac or orthopedic surgery in children. We hypothesized that intraoperative TXA would reduce blood transfusion relative to placebo in patients pretreated with erythropoietin. Methods Forty consecutive children, American Society of Anesthesiologists status 1 or 2, scheduled to undergo surgical correction of craniosynostosis were randomly assigned to receive either intravenous TXA or saline, 0.9%, intraoperatively. All children received preoperative erythropoietin (600 U/kg once a week for 3 weeks before surgery). Perioperative blood loss, number and volume of transfusions, percentage of children who underwent transfusion, and side effects were noted after surgery and at the end of the study. Surgeon satisfaction and cost of treatment were also recorded. Results There was no significant difference between groups in demographic or surgical data. In the TXA group, the volume of packed erythrocytes transfused was significantly reduced by 85% (from 11 to 1.6 ml/kg) intraoperatively and by 57% (from 16.6 to 7.2 ml/kg) throughout the study period (P &lt; 0.05). Compared with the placebo group, the percentage of children requiring blood transfusion was lower in the TXA group during surgery (9 [45%] of 20 vs. 2 [11%] of 19 children; P &lt; 0.05) and during the whole study period (14 [70%] of 20 vs. 7 [37%] of 19; P &lt; 0.05). Preoperative and postoperative hematologic parameters were comparable in both groups. There were no adverse events. Conclusion In children undergoing surgical correction of craniosynostosis and pretreated with erythropoietin, intraoperative TXA reduces the transfusion requirement.

scholarly journals The study of oropharyngeal pack soaked in lignocaine with dexamethasone in patients undergoing nasal surgeries

2020 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Mahendra Agrawal ◽  
Pushpal Gandhi ◽  
Bhavika Agrawal ◽  
Simarn Behl
Keyword(s):  
Blood Pressure ◽  
Retrospective Study ◽  
Systolic Blood Pressure ◽  
Sore Throat ◽  
Pressure Pulse ◽  
Postoperative Sore Throat ◽  
Significant Difference ◽  
Group A ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: The aim of this study determines the efficacy of lignocaine lignocaine with dexamethasone used topically in form of oropharyngeal pack in reducing postoperative sore throat (POST), hoarseness and throat irritation.  Methods: This retrospective study total of 70 adult patients included in the lignocaine and dexamethasone (LD) group. LD group patients received combination of 5 ml lignocaine 2% and 2 ml (8 mg) dexamethasone in oropharyngeal packing.Results: There is no significant difference in age, gender, and American society of anesthesiologists (ASA) grade I and II. There was no significant difference the studied group in term of measured hemodynamic indices Systolic blood pressure, diastolic blood pressure, pulse rate, and respiratory rate. Post extubation incidence of mild sore throat was occurred in patients 11 (31.4%) at 30 min, 13 (37.1%) at 2 hours, 6 (17.1%) at 6 hours, and 5 (14.2%) at 5 (14.2%). Moderate sore throat and severe sore throat was not present. Hoarseness of voice was present only 4 (11.4%) at 30 min. There was significant deference in throat irritation. A decrease in incidence of hoarseness was also seen in group LD.  Conclusions: In LD group a positive benefit is seen in form of reduction of POST, hoarseness and throat irritation helping in better recovery of patients.

scholarly journals The Effect of COVID-19 Pandemic on the Hip Fractures in Advanced Age

2021 ◽  
Author(s):  
Ahmet Metin Özsezen ◽  
Ahmet Burak Bilekli ◽  
Anıl Özgür ◽  
Onur Denizhan Sivri ◽  
Çağrı Neyişçi ◽  
...  
Keyword(s):  
Primary Care ◽  
Hip Fractures ◽  
The Elderly ◽  
Mortality Rates ◽  
Demographic Characteristics ◽  
Low Energy ◽  
Primary Care Unit ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists

Objective: Hip fractures due to domestic low-energy traumas are common problems that can cause significant morbidity and mortality in the elderly population. Since the Covid-19 outbreak, although the lock-down of older people could decrease contagion,the incidence of domestic traumas did not decrease, and led to development of various comorbidities. In this study, we aimed to compare the epidemiology of hip fractures in 6 months of the pandemic in 2020, with the equivalent 6-month period in the previous year to determine the relationship between lock-down and hip fractures due to domestic falls. Method: In this retrospective study, patients over 65 years old who were hospitalized due to hip fractures between May 1st, 2020 - November 30th, 2020 were compared with the similar cohort hospitalized between May 1st, 2019 - November 30th, 2019. The patients were compared in terms of demographic characteristics, American Society of Anesthesiologists (ASA) scores, type of anesthesia, time until surgery, comorbidities, surgical treatment modality, need for postoperative primary care unit, postoperative complications, and mortality. Results: Overall, 210 patients were included in our study. There was no significant difference between the groups regarding demographic characteristics and ASA scores. In the 2020 group, there were eight patients (8.6%) who were Covid-19 PCR- positive. There was no death proven by PCR that was related to COVID-19 disease. Time to surgery, fracture type, anesthesia type did not differ between the two groups. The need for a postoperative primary care unit was higher in the 2020 group. Ninety-day mortality rates were not significantly different between the two groups. Conclusions: In conclusion, despite higher mortality rates described in the literature, there was no Covid -19 associated mortality in our study. Hip fractures in the elderly did not alter with social mobilization; hence they usually occur due to domestic low- energy traumas. Reporting of the information in this patient group by all centers will provide important data in the management of hip fractures in this special process.

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